Abstract B23: Correlates of an informed decision regarding colorectal cancer screening among African Americans

Abstract

Abstract An informed decision is a critical factor in increasing colorectal cancer (CRC) screening rates. An informed decision is made without the benefit of a client-provider interaction and has occurred once an individual understands the disease or condition being addressed; understands the risks, limitation, benefits alternative and uncertainties of the screening method and makes the decision, to act or defer a decision at a later time, based on his or her screening preferences and values. CRC incidence and mortality are highest among African Americans and informed decision-making may be a strategy to decrease the disparity. However, little is known about informed decision-making among African Americans. The purpose of this study was to examine the correlates of an informed decision regarding CRC screening among older African Americans. The Preventive Health Model (PHM) guided the study as it proposes there are internal and external factors influencing preventive health-related actions and health-related actions are reflective of the self-system. A descriptive cross-sectional design was used. A community-based purposive sample of 129 AAs 50 years and older was recruited from an urban, Midwestern city. Study variables were measured with several instruments with established reliability and validity: Cultural identity (Cultural identity sub-scales), CRC beliefs (Colorectal Cancer Perceptions Scale), family/social support (MOS Social Support Survey), family influence (Family Influence Scale) and informed decision (Informed Decision Making Scale). Bivariate correlations, multiple regression and path analyses were used. For men, collectivism (r= .32, p = .000) and racial pride (r=.38, p=.000) were positively and significantly related to a CRC screening informed decision, but not for women. However, CRC beliefs were positively and significantly related to a CRC screening informed decision among men (r = .32, p =.000) and women (r = .25, p = .000). Family support was positively and significantly related to CRC beliefs that support CRC screening among the men (r= .50, p=.000) and the women (r= .45, p= .000). Family influence was not significant for either group. For women, cultural identity and family support accounted for 30% of the variance in CRC beliefs. CRC beliefs account for 6% of the variance in a CRC screening decision. Cultural identity and family support account for 44% of the variance in CRC beliefs and CRC beliefs accounted for 10% of the variance in a CRC screening decision among men. A gender covariate model was evaluated. The fit and misfit indices of the path analyses indicated the gender covariate model did not fit the data well. Fit of the model for each gender was examined. The female model fit the data better (λ∗ = 5.10, 6df, p = .531, n=65, NFI = .905, CFI = 1.00, RMSEA = .000) than the male model, which was a poor fit (X2 =14.90, 6df, p = .021, n= 64, NFI = .912, CFI = .933, RMSEA = .153). The results of this study provide preliminary support for the relationships between cultural identity, CRC beliefs that support CRC screening, family support and an informed decision regarding CRC screening for African Americans. The results provide preliminary support for gender differences in the decision making models of African American men and women. Additional research is warranted as there is a need for new strategies and intervention to decrease CRC disparities among African Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B23.